Provider Demographics
NPI:1891212353
Name:DE SILVA, MELISSA ANN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:DE SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905
Mailing Address - Street 2:BUSINESS CENTER DRIVE
Mailing Address - City:SAN BERNADINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:760-684-1544
Mailing Address - Fax:
Practice Address - Street 1:8546 WAGON WHEEL CT
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92344-0192
Practice Address - Country:US
Practice Address - Phone:760-684-1544
Practice Address - Fax:760-684-1544
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst